Along with some basic clinical information, a high-quality photo
taken with a modern smartphone can be a reliable way to get an
accurate dermatologic diagnosis, the study team argues in JAMA
Dermatology, online November 15.
Two categories of skin conditions could be more difficult to
diagnose remotely: hair disorders, such as alopecia, and deeper skin
lesions, including nodules and cysts, senior study author Dr.
Patrick McMahon of the Children's Hospital of Philadelphia said by
“We have also found that we cannot make specific diagnoses on some
images, but those images can be helpful in deciding if urgent office
visits are necessary,” said Dr. Lawrence Eichenfield, chief of
pediatric and adolescent dermatology at Rady Children's Hospital-San
Diego, who wasn’t involved in the study.
Despite the increasing popularity of telemedicine as a way to reduce
costs, improve time efficiencies and tackle geographic barriers to
care, adoption of this kind of remote care has been slowed by
barriers to reimbursement, cross-state licensing requirements and
uncertainty about privacy regulations, the authors and other experts
In the current study, a dermatologist assessed 87 images from 40
parent-patient pairs who also were seen in person by a different
dermatologist. Overall, the doctor who viewed photos and the doctors
who saw the same patients in person came to the same diagnosis 83%
of the time.
“While the authors did not test the usefulness of complete
teledermatology visits, which would include treatment plans,
prescribing medications, and giving patient educational materials,
they strongly showed diagnostic consistency within limits,”
The greatest number of incorrect diagnoses occurred in cases of
alopecia, but since one of the in-person clinicians specializes in
pediatric hair conditions, the study included an above-average
proportion of such cases, the researchers note. Such diagnoses can
also be difficult to differentiate without dermoscopy and a thorough
case history, they add.
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Prior studies of adults have found that so-called store-and-forward
teledermatology generates accurate diagnoses, improves access to
specialty care and reduces time to treatment, McMahon and colleagues
point out. Pediatric dermatologists are also in short supply, with
“fewer than 300 board-certified physicians serving the nearly 75
million children in the United States,” they write.
The authors acknowledge that the small trial simulated, rather than
performed, an actual teledermatology encounter. Another limitation
is that the study was conducted in a setting that was urban,
academic and clinic-based, and used a solitary pediatric
dermatologist to provide remote diagnoses.
“The patient population was very small to base any real conclusions
so it was more of a pilot study,” Dr. Bruce A. Brod, clinical
professor of dermatology at University of Pennsylvania Perelman
School of Medicine in Philadelphia, said by email. “The pediatric
dermatologists at CHOP function at the highest level, so the
question is whether this translates at the community level,” said
Brod, who wasn’t involved in the study.
McMahon said he was confident the study could be reproduced on a
larger scale, and if they decided to exclude certain conditions like
hair disorders and nodules, “we could exceed 90 percent in our
A study published in 2016 in the same journal raised concerns about
direct-to-consumer teledermatology websites, including the risk for
incorrect diagnoses, inappropriate treatments, a lack of information
about possible side-effects and a lack of transparency about a
doctor’s credentials (bit.ly/1srMuYU).
“I think more work needs to be done to assess the accuracy of
teledermatology and to determine the optimal type of care episodes
where this can be best utilized,” Brod said.
JAMA Dermatol 2017.
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